Aortic coarctation

Definition

Aortic coarctation is a narrowing of part of the aorta (the major artery leading the heart). It is a type of birth defect. Coarctation means narrowing.

Alternative Names

Causes

The aorta carries blood from the heart to the vessels that supply the body with blood and nutrients. If part of the aorta is narrowed, it is hard for blood to pass through the artery. People with this condition often have high blood pressure in the upper body and arms (or one arm) and low blood pressure in the lower body and legs.

Aortic coarctation is more common in persons with certain genetic disorders, such as Turner's syndrome

Aortic coarctation occurs in approximately 1 out of 10,000 people. It is usually diagnosed in children or adults under age 40.

Symptoms

Symptoms depend on how much blood can flow through the artery. In severe cases, symptoms are seen when the baby is very young. In milder cases, symptoms may not develop until the child has reached adolescence. Symptoms include:

• Dizziness or fainting
• Shortness of breath
• Pounding headache
• Chest pain
• Cold feet or legs
• Nosebleed
• Leg cramps with exercise
• Hypertension (high blood pressure) with exercise
• Decreased ability to exercise

Note: There may be no symptoms.

Exams and Tests

The health care provider will perform a physical exam and take your blood pressure in your arms and legs. Your pulse will be checked. The pulse in the femoral (groin) area is weaker than the carotid (neck) pulse. Sometimes, the femoral pulse may not be felt at all. .

The doctor will use a stethoscope to listen to your heart and check for murmurs. People with aortic coarctation have a harsh murmur that can be heard from the back.

Coarctation is often discovered during a newborn's first examination or a well-baby exam. Taking the pulses in an infant is an important part of the examination since there may not be any other symptoms or findings until the child is older.

Tests to diagnose this condition may include:

• Chest x-ray
• ECG
• Echocardiography
• Doppler ultrasound of the aorta
• Chest CT
• MRI of the chest
• Cardiac catheterization and aortography

Both Doppler ultrasound and cardiac catheterization can be used to see if there are any differences in blood pressure in different areas of the aorta.

Treatment

Surgery is usually recommended. The narrowed part of the aorta will be removed. If the problem area was small, the two free ends of the aorta may be re-connected. This is called anastomosis. If a large part of the aorta was removed, a Dacron graft (a synthetic material) is used to fill the gap

In some cases, balloon angioplasty may be done instead of surgery.

Outlook (Prognosis)

Coarctation of the aorta can be cured with surgery. Symptoms quickly get better after surgery.

However, there is an increased risk for death due to heart problems among those who have had their aorta repaired. But, without treatment, most people die before age 40. For this reason, doctors usually recommend that the patient has surgery before age 10. Most of the time, surgery to fix the coarctation is done during infancy.

Possible Complications

• Aortic aneurysm
• Aortic dissection
• Aortic rupture
• Severe hypertension
• Endocarditis
• Intracerebral hemorrhage
• Stroke
• Heart failure
• Premature development of coronary artery disease (CAD)
• Paraplegia (rare complication of surgery to repair coarctation)

When to Contact a Medical Professional

Call your health care provider if you or your child have symptoms of coarctation of the aorta.

Call your health care provider if fainting or chest pain develops; these may be signs of a serious problem.

Prevention

There is no known way to prevent this disorder, however, awareness of risk may make early diagnosis and treatment possible.